Why should enteric-coated or sustained-release medications not be crushed?

• A. Crushing enteric-coated or sustained-release meds changes absorption and release, increasing risk of toxicity or GI irritation.
• B. Crushing these meds improves safety by faster action.
• C. These meds are safe to crush if the patient cannot swallow.
• D. Crushing has no impact on effectiveness.

Answer: (A)

Enteric-coated and sustained-release formulations are designed to release a drug in a specific way to achieve predictable absorption and safety. The enteric coating is a barrier that resists stomach acid and only dissolves in the higher pH of the small intestine. Crushing breaks that coating, so the drug can release in the stomach, potentially irritat­ing or damaging the gastric lining and altering how much of the drug is absorbed. This can lead to unpredictable absorption and a higher risk of toxicity or adverse effects.

Sustained-release (extended-release) formulations aim to release the drug slowly over several hours to keep a steadier blood level. When you crush them, the controlled, gradual release is lost, causing a rapid surge in drug levels (a dose-dump). This increases the risk of toxicity and side effects and shortens the intended duration of action, defeating the purpose of the sustained-release design.

Because of these risks, these formulations should not be crushed unless a clinician specifically directs otherwise and an appropriate alternative form is available. If swallowing is a problem, consult the healthcare team about safe alternatives or routes.